karen peifer phd, mph, rn roopa iyer phd ann kaskel rn does place matter for healthy early child...

Karen Peifer PhD, MPH, RNRoopa Iyer PhDAnn Kaskel RN

Does Place Matter For Healthy Early Child Care Environments?

Disclosure

• The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

• We have no conflicts to report

State BoardStatewide: Policy, Infrastructure, Programs,

Coordination and Collaboration

Regional Partnership CouncilsLocal Decision making, Community Coordination and

Collaboration, Targeted Programs

Grantees and PartnersPrograms and Services to Children and Families

First Things FirstGovernance Model

What impacts quality and does place Matter?

Quality First- QRIS Child Care Health Consultation

• Improve health and safety standards in child care settings– Standards based on Caring for

Our Children, 3rd Edition

• CCH Consultant: – National Training Institute

(NTI) trained and certified professionals- post BA or BSN

PRO

FESS

ION

AL

DEV

ELO

PME

NT

Environmental Rating Scales: ECERS-R; ITERS and FCCERS

• Personal Care Routines Subscale

CLASS: Classroom Assessment Scoring System

Quality First Rating Scale

FTF Quality First Point Scale• Staff Qualifications• Administrative Practices• Curriculum

Personal Care Routines Scale

• Greeting and departing • Meals and snacks • Nap and rest • Toileting and diapering • Health practices• Safety Practices

Child Care Health Consultation

Tier 3

Tier 2

Tier 1 CCHC collaborate with QF Coaches Telephonic technical assistance and resource

Expert mode consultation (short term) + Tier 1 services

National Health and Safety Assessment Collaborative model of consultation Individualized instruction & training: Clinical pathway Identify & train an on-site Health & Safety Specialist + Tier 1 and 2 services

Hypothesis: Does Place Matter?

Location of a child care center make a difference in quality of child care environments. • H1: The scores on the Environmental Rating Scale

(ERS) subscale for personal care routines (PCR) will vary in high poverty areas compared to non-poverty areas in the state.

• H2: The scores on the ERS and PCR will differ based on level of CCHC services.

• H2: The Center quality rating scores is illustrated by ERS and PCR scores

Methodology

• Child care centers enrolled in the Quality First Program (n = 670)

• Scores on ERS for Personal Care Routines sub-scale• Calculated low poverty areas based on poverty of

geographic region where the center is located (ACS 2008 - 2012).

• Comparing the tier levels of CCHC services – Tier 1 (less intensive) to tier 3 (more intensive services)

• Quality Rating scores by PCR and ERS scores

Limitations

• Administrative data• Limited Data

• Sub-categories for poverty• Dose of CCHC intervention - New data system• ERS subscale scores in relation to length of program

participation and assessment by different time points

Center-based Child Care CentersCenters Number of Centers

Cohort 1 CCHC Tier 2 & 3 (n = 299)

Public : School based, Head Start and early childhood

special education

57 (19%) 15 Head Start, (7 are tribal Head

Start)

Private child care 242 (81%)

Cohort 2 CCHC Tier 1 (n = 371)Public : School based, Head

Start and early childhood special education

119 (32%)

Private child care 252 (68%)

ResultsCohort 1

Centers (299)n FPL Average ERS by

poverty levelERS

PCR scores

Exposed to CCHC Tiers 2 & 3 (On-site

consultation)

171 < 150% FPL 3.23 2.06

128 >= 150% FPL 3.23 2.08

Cohort 2Centers (371)

Exposed to CCHC Tier 1 (Phone

consultation only)

262 < 150% FPL 3.33 2.15

109 >= 150% FPL 3.53 2.43

ResultsCohort 1: Centers (299)

CCHC Tiers 2 & 3 PCR scores Average ERS

210 (Star rating 1-2) 1.92 2.97

89 (Star rating 3-5) 2.51 4.02

Cohort 2:Centers (371)CCHC Tier 1

PCR scores Average ERS

215 (Star rating 1-2) 2.05 3.22

156 (Star rating 3-5) 2.45 3.95

Conclusion

• We expected that low poverty areas with limited CCHC services would have lower PCR scores than in higher poverty levels. Scores varied but not in the direction we assumed when more intensive CCHC services were delivered.

• Goals for CCHC interventions are similar but slightly different from the PCR rating scores.

• Importance in aligning goals between coaches, CCHC and other specialized technical assistants.

• Lessons learned.

Next StepsQuality First Implementation and Validation study

Are the quality first improvement components implemented as intended (fidelity of implementation)? Which ones or what combination works best in moving programs to higher quality levels (star ratings)?

• Consulting Team: CCHC, Mental Health consultation in some regions

• Coaching consultation model• Professional development• Financial incentives

Questions/Comments

Thank you

Karen Peifer PhD, MPH, RNRoopa Iyer PhDAnn Kaskel RN